Abstract
BackgroundNecrotic pulmonary lesions manifest as relatively low-density internally on contrast-enhanced computed tomography (CT). However, using CT to differentiate malignant and benign necrotic pulmonary lesions is challenging, as these lesions have similar peripheral enhancement. With the introduction of dual-energy spectral CT (DESCT), more quantitative parameters can be obtained and the ability to differentiate material compositions has been highly promoted. This study investigated the use of kVp-switching DESCT in differentiating malignant from benign necrotic lung lesions.MethodsFrom October 2016 to February 2019, 40 patients with necrotic lung cancer (NLC) and 31 with necrotic pulmonary mass-like inflammatory lesion (NPMIL) were enrolled and underwent DESCT. The clinical characteristics of patients, CT morphological features, and DESCT quantitative parameters of lesions were compared between the two groups. Binary logistic regression analysis was performed to identify the independent prognostic factors differentiating NPMIL from NLC. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of single-parameter and multiparametric analyses.ResultsSignificant differences in age, C-reactive protein concentration, the slope of the spectral curve from 40 to 65 keV (K40–65 keV) of necrosis in non-contrast-enhanced scanning (NCS), arterial phase (AP) and venous phase (VP), effective atomic number of necrosis in NCS, and iodine concentration (IC) of the solid component in VP were observed between groups (all p < 0.05). The aforementioned parameters had area under the ROC curve (AUC) values of 0.747, 0.691, 0.841, 0.641, 0.660, 0.828, and 0.754, respectively, for distinguishing between NLC and NPMIL. Multiparametric analysis showed that age, K40–65 keV of necrosis in NCS, and IC of the solid component in VP were the most effective factors for differentiating NLC from NPMIL, with an AUC of 0.966 and percentage of correct class of 88.7%.ConclusionsDESCT can differentiate malignant from benign necrotic lung lesions with a relatively high accuracy.
Highlights
Necrotic pulmonary lesions manifest as relatively low-density internally on contrast-enhanced com‐ puted tomography (CT)
In clinical practice, we have found that many necrotic pulmonary mass-like inflammatory lesion (NPMIL) may mimic necrotic lung cancer (NLC), leading to unnecessary surgery in patients with inflammatory masses
We found that the CT morphological findings of NLC were similar to those of NPMIL, indicating that conventional CT cannot provide enough information on necrosis, and it is desirable to develop a new imaging technique that can extract additional quantitative information regarding necrosis
Summary
Necrotic pulmonary lesions manifest as relatively low-density internally on contrast-enhanced com‐ puted tomography (CT). Conventional CT has been widely known to provide valuable morphological information regarding pulmonary lesions [1, 3], but it is unable to supply sufficient quantitative parameters concerning necrosis, except for conventional CT attenuation values, which are not always helpful in determining whether necrotic lung masses are benign or malignant. Additional tests such as percutaneous lung biopsy and empirical anti-infective therapy are often required
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